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Biomedical subjects

A Sterr

Publications and source records attributed to A Sterr.

14 recordsLinked to original sources
PubMed2002

Exploring a repetitive training regime for upper limb hemiparesis in an in-patient setting: a report on three case studies.

PRIMARY OBJECTIVE: To explore the efficacy of a task-oriented repetitive training protocol (RTx) in chronic hemiparetic patients in an in-patient rehabilitation unit. RESEARCH DESIGN: Three case studies; ABAB design (A=RTx; B=regular rehabilitation programme; 1 week per phase, respectively) in case P1, pre-post intervention comparison in case P2; repeated measure design in case P3. METHODS AND PROCEDURES: Daily training of task-oriented affected hand movements using shaping procedures developed in Constraint-Induced (CI) Movement Therapy. Patients 1 and 2 were trained daily for 90 minutes over 2 weeks. Patient 3 received 60 minutes of daily training for a period of 4 weeks. Outcome measures were Wolf Motor Function Test (WMFT), Frenchay Arm Test, nine-hole peg test, upper extremity MRC, and grip force. MAIN OUTCOMES AND RESULTS: Substantial clinical benefits were achieved in all patients. The subjective observations mirrored significant improvements in the outcome parameters. CONCLUSION: The affected hand training improves upper limb motor functions in chronic patients. It is a 'practicable' approach for in-patient rehabilitation units.

Adolescent↗
PubMed2001

Central pontine myelinolysis in a patient with anorexia nervosa.

UNLABELLED: Myelinolysis may occur as a severe complication of eating disorders, especially anorexia nervosa (AN). One of the most important reasons can be a rapid correction of hyponatremia caused by tubulopathy, water intoxication (WI), or abuse of diuretics in individuals with AN. METHOD AND RESULTS We report on a 24-year-old female patient with an 8-year history of AN. A rapid correction of severe hyponatremia and hypokalemia induced by WI led to central pontine myelinolysis, which was confirmed by magnetic resonance imaging (MRI) examination. Besides affective lability, incoherence, and an acute confusional state, surprisingly, no severe neurological symptoms emerged. CONCLUSION: Thus, physicians should be aware of the risk of pontine myelinolysis with new psychiatric symptoms emerging in the absence of obvious neurological deficits.

Adult↗
PubMed2001

[Clinical relevance and treatment possibilities of rapid cycling in patients with bipolar disorder].

In the actual version of the WHO diagnostic guidelines, the ICD-10, subtypes of bipolar disorder are not specified, in contrast to the American DSM-IV, where bipolar disorder has already been differentiated in bipolar I (severe manic and depressive episodes) and bipolar II disorder (depressive and hypomanic episodes). Furthermore, aspects of the longitudinal course of the illness, like rapid cycling (RC), are reflected as well. Rapid cycling is defined as four or more affective episodes within one year of the illness. It has been postulated that rapid cycling is related with a poor response to lithium, to the same extent as mixed episodes or an atypical onset (depressive episode first) of the disease. Here, the current status of alternative pharmacological and supportive therapy of rapid cycling is presented and discussed. Furthermore, the article also displays biological parameters associated with rapid cycling like higher prevalence in women, hypothyreoidism, subtype of bipolar disorder, COMT-allele, influence of sleep or risk of antidepressant induced cycling.

Animals↗
PubMed2001

Antimanic efficacy of topiramate in 11 patients in an open trial with an on-off-on design.

BACKGROUND: A series of open studies suggests that topiramate has efficacy in bipolar disorder. To further investigate the potential value of topiramate as an antimanic agent, we conducted an open trial in 11 manic patients. METHOD: Eleven patients with bipolar I disorder with an acute manic episode (DSM-IV) were treated with a mood stabilizer and/or antipsychotics in sufficient and fixed doses. All had a Young Mania Rating Scale (YMRS) score of at least 24 (mean +/- SD = 33.5+/-8.1). Topiramate was added after stable plasma levels of concomitant mood stabilizers had been reached and was titrated within 1 week to a final dose in the range of 25 to 200 mg/day, depending on clinical efficacy and tolerability. Topiramate was discontinued after 10 days, while concomitant medication remained unchanged. After 5 days, topiramate was reintroduced at similar or increased dosages for another 7 days. Patients were assessed with the YMRS; the Clinical Global Impressions scale version for bipolar patients; and the 21-item Hamilton Rating Scale for Depression. RESULTS: Seven of the 11 patients initially showed a good antimanic response with > 50% reduction in YMRS score. One patient showed psychotic features following rapid increase in topiramate dosage and dropped out on day 10. After discontinuation of topiramate, 7 of the remaining 10 patients worsened (increase of > or = 25% in YMRS score), 2 remained stable, and 1 discontinued follow-up after good recovery. After reintroducing topiramate, all patients improved again within a week, with 8 of 9 meeting the responder criterion of > or = 50% YMRS score reduction when comparing baseline values with those of day 22. With the exception of the patient who developed psychosis, topiramate was well tolerated. Concomitant medication did not interfere with plasma levels of drug, except for carbamazepine level in 1 patient. CONCLUSION: The antimanic response among patients in this study appears reproducibly linked to the addition of topiramate.

Adult↗
PubMed2000

[Effectiveness, safety and practicality of delayed-release minitablets of valproate in bipolar affective disorders].

UNLABELLED: Valproate has recently emerged as a drug of first choice in treating acute mania because of its efficacy and relative safety. It can be administered as an intravenous, oral non-sustained release or oral sustained release loading therapy. A new sustained release formulation of valproate consists of "mini-tablets" with the possible advantage of a less problematic and more reliable administration of the drug. We report on eleven patients with an acute manic exacerbation who were investigated for sufficient control of manic symptoms and the duration of building up and maintaining sufficient blood levels of valproate in once/d versus twice/d administration of valproate delayed release mini-tablets (VPA mrt.). Acute and prophylactic effectiveness in mania were rated with the Young-Mania Rating Scale (YMRS), respectively the Global Clinical Impression Scale for Bipolar Disorder (CGI-BP). RESULTS: Within a short period of time sufficient blood levels in both groups (once/d versus twice/d administration) were built up. Seven of eleven patients were responders according to a reduction of 50% of the YMRS. In respect of prophylactic treatment all of the ten patients showed satisfactory results and no re-exacerbation of manic symptoms or depression.

Adult↗
PubMed2000

Psychopathological changes preceding motor symptoms in Huntington's disease: a report on four cases.

Neurodegenerative disorders often exhibit "classical" psychiatric symptoms as an initial presentation of the disease. Here we present four patients with different psychopathological abnormalities who were later diagnosed as having Huntington's disease. The range of symptoms covered affective and psychotic symptoms, antisocial behavior, cognitive problems reminiscent of dementia and suicidal idealisation. The pattern of progress of neuronal degeneration may be helpful in explaining the antecedent manifestation of psychiatric symptoms.

Adult↗
PubMed1999

Improved auditory spatial tuning in blind humans.

Despite reports of improved auditory discrimination capabilities in blind humans and visually deprived animals, there is no general agreement as to the nature or pervasiveness of such compensatory sensory enhancements. Neuroimaging studies have pointed out differences in cerebral organization between blind and sighted humans, but the relationship between these altered cortical activation patterns and auditory sensory acuity remains unclear. Here we compare behavioural and electrophysiological indices of spatial tuning within central and peripheral auditory space in congenitally blind and normally sighted but blindfolded adults to test the hypothesis (raised by earlier studies of the effects of auditory deprivation on visual processing) that the effects of visual deprivation might be more pronounced for processing peripheral sounds. We find that blind participants displayed localization abilities that were superior to those of sighted controls, but only when attending to sounds in peripheral auditory space. Electrophysiological recordings obtained at the same time revealed sharper tuning of early spatial attention mechanisms in the blind subjects. Differences in the scalp distribution of brain electrical activity between the two groups suggest a compensatory reorganization of brain areas in the blind that may contribute to the improved spatial resolution for peripheral sound sources.

Adult↗
PubMed1998

Failure of dominant left-hemispheric activation to right-ear stimulation in schizophrenia.

Schizophrenia is associated with an absence of the lateralizations that typify the human brain. Previous evidence emphasized structural changes, particularly reduced asymmetry in extension and surface of the planum temporale, although gross structural deviations occur only in a minority of patients. The present study describes an absence of lateralization on a robust functional measure that characterized schizophrenia patients: healthy subjects but not schizophrenics displayed a contralateral left-hemispheric dominance of the auditory evoked magnetic field to right-ear auditory stimulation. Absence of contralateral dominance in response to auditory stimuli among schizophrenia patients may indicate a failure to establish unequivocal left-hemispheric dominance of the phonological loop as hypothesized by Crow.

Acoustic Stimulation↗
PubMed1998

Alteration of digital representations in somatosensory cortex in focal hand dystonia.

Focal hand dystonia involves a loss of motor control of one or more digits; it is associated with the repetitive, synchronous movements of the digits made by musicians over periods of many years. Magnetic source imaging revealed that there is a smaller distance (fusion) between the representations of the digits in somatosensory cortex for the affected hand of dystonic musicians than for the hands of non-musician control subjects. The data suggest that use-dependent susceptibility to digital representation fusion in cortex may be involved in the etiology of focal dystonia. A successful therapy for the condition has been developed based on this consideration.

Adult↗
PubMed1998

Perceptual correlates of changes in cortical representation of fingers in blind multifinger Braille readers.

The mature mammalian nervous system alters its functional organization in a use-dependent manner. Enhanced stimulation of a body part enlarges its cortical representational zones and may change its topographic order. Little is known about the perceptual and behavioral relevance of these plastic alterations in cortical organization. We used blind Braille readers who use several fingers on each hand and who do so for many hours each day as a model to investigate this issue. Magnetic source imaging indicated that the cortical somatosensory representation of the fingers was frequently topographically disordered in these subjects; in addition, they frequently misperceived which of these fingers was being touched by a light tactile stimulus. In contrast, neither the disordered representation nor mislocalizations were observed in sighted controls. Blind non-teacher Braille readers who used only one finger for reading were not significantly different from the sighted controls. Thus, use-dependent cortical reorganization can be associated with functionally relevant changes in the perceptual and behavioral capacities of the individual.

Adult↗
PubMed1997

Dynamical aspects of the EEG in different psychopathological states in an interview situation: a pilot study.

Dynamical brain states can be characterized by non-linear measures of EEG. The present study shows that critical transitions, i.e., abrupt changes from one dynamic pattern of neural mass activity to another one, may be detected by abrupt variations in local chaoticity. Using an ambulatory device, EEG was recorded from 10 patients with a schizophrenic and two patients with an affective disorder during a series of 25-min interviews. Dynamical aspects, in particular, phase transitions in the EEG-dynamics of the EEG were characterized by means of a measure that continuously estimates the chaoticity of the EEG signal and is thus related to its predictability. Results indicate simpler dynamics of the EEG time series in paranoid-hallucinatory patients, while at the same time these patients tended to exhibit more abrupt transitions/unit of time between different dynamical EEG states. Such sudden phase transitions in brain activity were significantly enhanced prior to expressions of thought disorders that were detected by the interviewer and an observer in the conversation, compared with time periods during the interview without such symptoms.

Adult↗
PubMed1997

Input-increase and input-decrease types of cortical reorganization after upper extremity amputation in humans.

A plastic remodeling of regions in somatosensory cortex has previously been observed to occur in separate experimental paradigms in response to loss of somatosensory input and to increase in input. In this study, both types of cortical reorganization have been observed to occur concurrently in the same adult human nervous system as a result of a single intervention. Following upper extremity amputation, magnetic source imaging revealed that tactile stimulation of the lip evoked responses not only in the area of the somatosensory cortex corresponding to the face, but also within the cortical region that would normally correspond to the now absent hand. This "invasion" of the cortical amputation zone was accompanied by a significant increase in the size of the representation of the digits of the intact hand, presumably as a result of an increased importance of sensory stimulation consequent to increased dependence on that hand imposed by the loss of the contralateral extremity.

Adolescent↗